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Background: Chordoma is a rare bone cancer arising from the embryonic notochord with special predilection to the axial skeleton. The locally destructive nature and metastatic potential of chordomas can lead to devastating outcomes in terms of survival. The purpose of this study was to examine potential risk factors predictive of metastatic disease at presentation and prognostic factors in patients with metastasis., Methods: SEER was used to classify each patient as having metastatic or localized disease at the time of diagnosis. Patient-specific and tumor characteristics were analyzed to determine which factors were predictive of an increased rate of metastatic disease at presentation. These factors were analyzed using univariate as well as a multivariate logistic regression model. Prognostic factors for survival were analyzed using the Kaplan-Meier estimates with log-rank tests, and Cox proportional hazards models., Results: We identified 1,241 cases of chordoma affecting the axial skeleton, and 117 (9.4%) of the patients presented with metastatic disease. The most common locations for metastasis at presentation were lung (6.0%), followed by bone (5.1%) and liver (3.4%). Based on the unadjusted logistic regression analysis, patients had the highest odds of metastatic disease at presentation if they had a tumor located in the sacrococcygeal area (OR = 1.72; 95% CI, 1.11-2.68; p = .015), a tumor with a dedifferentiated histological subtype (OR = 7.42; 95% CI, 2.31-23.79; p = .001) and a tumor size greater than 10 cm (OR = 4.57; 95% CI, 2.52-8.28; p = .009). Only the histological subtype remained significant when combined in a multivariate model controlling for age, sex, race, tumor location, histology, and size. For patients with recorded tumor size information (n = 858), the odds of metastasis at presentation increased by 12.2% with each additional centimeter of tumor size (OR = 1.122; 95% CI, 1.072-1.175; p < .0001). However, this lost significance in the multivariate model. Advanced age (hazard ratio, 2.06; 95% confidence interval, (1.18-3.60); p = .011) and dedifferentiated subtype (hazard ratio, 4.7; 95% confidence interval, (1.33-16.8); p = .02) were significant prognostic factors for survival in patients with metastatic chordoma., Conclusions: Chordoma patients with dedifferentiated histological subtype were more likely to have metastatic disease at presentation. Advanced age and dedifferentiated histological subtype were independent predictors of increased mortality in patients with metastatic chordoma. Identification of this high-risk group may help providers in counseling their patients regarding the likelihood of discovering metastatic disease at the time of diagnosis of chordoma and predicting long term prognosis., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Inc. on behalf of North American Spine Society.)

Background: The avian pathogen Salmonella Gallinarum causes avian typhosis in laying hens, leading to high mortality rates among adult birds, which poses a significant problem in the poultry industry. Various products, such as vaccines, antibiotics, probiotics, and disinfectants, are commonly used to prevent and control the disease on farms. An alternative to these products is the use of bacteriophages, which may effectively prevent the colonization of S. Gallinarum., Materials and Methods: This study evaluated the safety of SalmoFree ® , a bacteriophage cocktail, administered to 276 laying hens from the first week of age until the 28th week. The hens were divided into two groups: a control group (138 birds) and a treatment group (138 birds). Over the 28-week period, eight doses of SalmoFree ® (∼10 10 UFP per bird) were administered via drinking water in a controlled environment., Results: The results indicate that the consumption of SalmoFree ® has no adverse effects on bird health or zootechnical parameters. Additionally, there is a trend toward improving weight homogeneity (up to 19%), feed conversion (up to 68%), and egg weight (up to 2.7%). The detection of phages by PCR in cloacal swabs suggests that they persist in birds for 2 to 8 weeks post-ingestion. Furthermore, phages were detected in organs and eggshells, indicating that they provide protection beyond the gut., Conclusion: The study demonstrates that SalmoFree ® is safe for use in laying hens and may offer additional benefits, such as improved zootechnical parameters and extended protection against S. Gallinarum through the persistence of bacteriophages in the birds., (Copyright 2024, Mary Ann Liebert, Inc., publishers.)

Background: Approximately 50% of patients with congenital scoliosis will require surgical treatment to prevent further progression. Outcomes following congenital scoliosis are sparse in the literature. The purpose of this study was to identify independent risk factors associated with unplanned readmission and prolonged length of stay (LOS) in patients undergoing primary surgical treatment for congenital scoliosis., Methods: The National Surgical Quality Improvement Database-Pediatric was queried for database years 2016-2018 to identify patients with congenital scoliosis who underwent primary posterior fusion of the spine. Patient demographics, comorbidities, and operative variables, such as the number of levels fused and the American Society of Anesthesiologists (ASA) classificaiton, were collected. Univariate and multivariate analyses of patient factors were performed to test for association with readmission within 30 days and prolonged LOS (>4 days)., Results: Eight hundred sixteen patients were identified. The average age was 11.3 ± 4.02 years, and the mean postoperative LOS was 4.64 ± 3.71 days. Forty-three patients (5.40%) were readmitted, and 73 patients (8.96%) had prolonged LOS. Independent risk factors associated with prolonged LOS included chronic lung disease ( P < 0.001), presence of a tracheostomy ( P < 0.001), structural central nervous system abnormality ( P = 0.039), oxygen support ( P < 0.001), and number of levels fused ( P = 0.008). The factors independently associated with unplanned readmission were fusion to the pelvis ( P = 0.004) and LOS >4 days ( P = 0.008)., Conclusions: Prolonged LOS and readmission are widely being used as quality and performance metrics for hospitals. Congenital scoliosis, which often progresses rapidly resulting in significant deformity, frequently requires surgery at an earlier age than idiopathic and neuromuscular deformity. Nevertheless, 30-day outcomes for surgical intervention have not been thoroughly studied. The present study identifies risk factors for prolonged LOS and readmission, which can facilitate preoperative planning, patient/family counseling, and postoperative care., Clinical Relevance: Congenital scoliosis management poses certain challenges that may be mitigated by understanding the risk factors for adverse outcomes following primary fusion surgery., Competing Interests: Declaration of Conflicting Interests : The authors report no conflicts of interest in this work., (This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2024 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.)

Background: Posterior cervical decompression with or without fusion (PCD/F) is used to manage degenerative spinal conditions. Malnutrition has been implicated for poor outcomes in spine surgery. The aim of this study was to assess the ability of the Geriatric Nutritional Risk Index (GNRI) as a risk calculator for postoperative complications in patients undergoing PCD/F., Methods: The 2006 to 2018 American College of Surgeons National Surgery Quality Improvement Program Database was queried for patients undergoing PCD/F. Nutritional status was categorized as normal (GNRI greater than 98), moderately malnourished (GNRI 92-98), or severely malnourished (GNRI less than or equal to 92). Complications within 30 days of surgery were compared among the groups. Preoperative data that were statistically significant ( P < 0.05) upon univariate χ 2 analysis were included in the univariate then multivariate binary regression model to calculate adjusted ORs. All ORs were assessed at the 95% CI., Results: Of the 7597 PCD/F patients identified, 15.6% were severely malnourished and 19.1% were moderately malnourished. Severe and moderate malnourishment were independent risk factors for mortality (OR = 3.790, 95% CI 2.492-5.763, P < 0.001; OR = 2.150, 95% CI 1.351-3.421, P = 0.011). Severe malnourishment was an independent risk factor for sepsis/septic shock (OR = 3.448, 95% CI 2.402-4.948, P < 0.001)., Conclusions: In elderly patients undergoing PCD/F, severe malnutrition, as defined by the GNRI, was an independent risk factor for mortality and sepsis/septic shock., Clinical Relevance: The GNRI may be more useful than other indices for risk stratification in elderly patients because it accounts for confounding variables such as hydration status and paradoxical malnourishment in obese patients., Competing Interests: Declaration of Conflicting Interests : The authors report no conflicts of interest in this work., (This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2023 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.)

Although most research focused on the northern Gulf of Mexico for western Atlantic bluefin tuna, the histological records of reproductive activity of this species in the southern Gulf of Mexico (Mexican waters) have been presented for the first time. This work is the first to study oocyte dynamics in Atlantic bluefin tuna caught in the southern Gulf of Mexico by assessing and comparing them with Mediterranean stock (BFT-E) through stereology using two different methods. Regardless of Atlantic bluefin tuna females returning to their respective spawning grounds at different months in the southern Gulf of Mexico and the Mediterranean, both stocks arrived reproductively inactive and remained in these zones during periods of similar length; they were reproductively active until March for the southern Gulf of Mexico and May for the Mediterranean females. The comparison of the size structure between the two stocks examined using kernel density estimators demonstrated a quite remarkable difference in mean fork lengths between stocks. The ovarian oocyte density, that is, the number of oocytes per gram of ovary, for each gonad stage predicted using the Weibel and Gomez and oocyte packing density (OPD) methods did not significantly differ between stocks and showed that advanced vitellogenic oocytes from spawning-capable females are an appropriate indicator to estimate potential fecundity, presenting values of c. 1273 and ~1355 eggs per gram for the southern Gulf of Mexico and Mediterranean females, respectively. Females caught in Mexican waters (southern Gulf of Mexico) were larger than those caught in the Mediterranean; however, it was demonstrated that the length and weight of females did not affect ovarian oocyte density production. In addition, densities estimated for each gonad stage using W&G and OPD methods did not differ between stocks and presented equal patterns in their oocyte dynamics. These findings contribute to a better understanding of the reproductive biology of Atlantic bluefin tuna, especially in the southern Gulf of Mexico, due to the lack of information regarding this zone, and may allow to support strategies for proper assessment, management, and conservation., (© 2023 Fisheries Society of the British Isles.)

Background: For patients with back pain from osteoporotic vertebral compression fractures (VCFs), vertebral augmentation remains the most utilized surgical intervention. Previous studies report 30-day readmission and mortality rates of up to 10% and 2%, respectively. These studies, however, have included patients with pathologic fractures and combined patients in different admission settings. We undertook the current study to address such shortcomings, which make risk stratification and appropriate counseling difficult., Methods: Four consecutive years of the National Surgical Quality Improvement Program database were queried. Patients who underwent vertebral augmentation for osteoporotic VCFs were divided into 3 groups: (1) outpatient group (defined as patients with same-day discharge), (2) inpatient group (defined as those who were admitted postoperatively), and (3) preprocedure hospitalized group (defined as those who were already inpatient or were at acute/intermediate care facilities and transferred). Postoperative 30-day complications and readmission rates were compared between different groups and examined using multivariate analyses., Results: A total of 1023 patients underwent outpatient surgery; 503 were admitted on the day of surgery; and 149 patients were already in-hospital or were transferred from other facility. Mortality rates were 0.68%, 0.60%, and 2.68%, and readmission rates were 6.26%, 6.76%, and 12.8%, for outpatient, inpatient, and preprocedure hospitalization cohorts, respectively. Multivariate analyses identified preprocedure hospitalization as an independent risk factor for urinary tract infection (UTI; OR = 3.98, 95% CI = 1.41-11.20, P = 0.028), pneumonia (OR = 19.69, 95% CI = 3.81-101.65, P < 0.001), readmission (OR = 1.86, 95% CI = 1.06-3.26, P = 0.032), and mortality (OR = 4.49, 95% CI = 1.22-16.53, P = 0.024)., Conclusion: Our findings suggest that published rates of complications and mortality are substantially impacted by the cohort of patients who are already hospitalized or transferred from other facilities. Such patients are at a higher risk of UTI, pneumonia, readmission, and mortality. Conversely, we show that a relatively healthy patient being offered outpatient same-day augmentation has a readmission risk 40% lower and a mortality risk 3 times lower than previously reported., Competing Interests: Declaration of Conflicting Interests : The authors report no conflicts of interest in this work., (This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2023 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.)

Purpose: To assess the efficacy and safety of intrawound antibiotics in posterior fusions for adolescent idiopathic scoliosis (AIS)., Methods: The NSQIP-Pediatric databases 2016-2018 were utilized. Patients 10 years of age or older with AIS who underwent posterior fusion were selected and divided into two cohorts based on the receipt of intrawound antibiotics. Patient characteristics and complications were compared. Multivariate analyses were performed to determine the efficacy and safety of intrawound antibiotics., Results: A total of 4203 patients received intrawound antibiotics while 879 patients did not. The intrawound antibiotic group had longer constructs, higher blood loss, and longer operative times, factors historically associated with higher infection rates. Those that received intrawound antibiotics had SSI rate of 0.69%, while its counterpart had 0.57% (p = 0.689). The reoperation rates were 1.12% and 1.25% (p = 0.735), for those with and without intrawound antibiotics, respectively. In multivariate analyses, intrawound antibiotics use was not found to be a significant predictor for SSI, any complications, reoperation and readmission., Conclusion: The current study represents the largest AIS surgery cohort studied to evaluate the efficacy of intrawound antibiotics. Our analysis failed to demonstrate association between the use of intrawound antibiotics and reduction in SSI. While other studies have reported seroma, wound dehiscence and renal failure with the practice, we did not observe an increased rate of such complications. This study highlights the difficulty of understanding the role for individual infection prevention measures in current surgical settings, where the SSI rate for the control group was substantially lower than 1%., (© 2022. The Author(s), under exclusive licence to Scoliosis Research Society.)

Introduction: Acne is a multifactorial disease involving the colonization of skin follicles by Cutibacterium (formerly Propionibacterium ) acnes . A combination of different retinoid-derived products, antibiotics, and hormonal antiandrogens are used to treat the disease, but these treatments require extended periods, may have secondary effects, are expensive, and not always effective. Owing to antibiotic resistance, the use of bacteriophages has been proposed as an alternative treatment. However, if they are intended for a cosmetic or pharmaceutical use, it is necessary to evaluate the safety of the phages and the preparations containing them., Materials and Methods: In this study, the cytotoxicity of Pa.7 bacteriophage was evaluated in HaCaT cells, along with a liposome suitable for their encapsulation, using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and trypan blue assays., Results: We found that Pa.7 was not cytotoxic for HaCaT cells. Also, 30 mM of liposomes, or below are considered noncytotoxic concentrations., Conclusion: Phages encapsulated in the liposomes presented in this study can be used safely for skin treatments., Competing Interests: M.J.V. declares she was in the past a member of the spin-off company SciPhage S.A.S., which works for the development of phage therapy in Colombia. She is also among the inventors of the patent no. NC2018/0008178, entitled “Composicionestópicas que comprendenbacteriófagos que se encapsulanenliposomas” (Topical compositions comprising bacteriophages encapsulated in liposomes). Other authors declare no competing interests., (Copyright 2023, Mary Ann Liebert, Inc., publishers.)

Bioaugmentation has many applications as a bioremediation technique. It is usually performed by bacteria but microalgal consortia also have great potential for bioremediation. This study evaluated the ability of a microbial consortium with predominance of microalgae (MCPM) to decontaminate the water of the Mallorquín tropical swamp. The Mallorquín Swamp is a natural water reservoir, essential for the ecological and hydric balance of the region, as well as for the fishermen, but has received sewage for more than 20 years. Microalgae for bioremediation purposes were isolated from the swamp, selected, cultured in bioreactors, and poured back into the Mallorquín waters. After bioaugmentation, there was a significant reduction in the BOD 5 (98%), nitrates (58%), enterococci (92%), and total coliforms (100%). Notably, despite the MCPM bioaugmentation, the original richness and abundance of phytoplankton in the Mallorquín swamp was not disrupted. These results confirm the benefits of phycoremediation as an effective tool for on-site bioremediation of natural water bodies and show an effective phycoremediation at a large scale without altering the autochthonous microalgae community. This constitutes the first report of a successful MCPM intervention performed at this scale in a natural swamp in Colombia., Supplementary Information: The online version contains supplementary material available at 10.1007/s12088-021-00990-y., (© Association of Microbiologists of India 2021.)

Context: Delayed, postoperative, spine infections are rare, most commonly occurring secondary to fastidious, less virulent pathogens. The etiology may involve a distant infectious focus, not related to the index operation. Patients may present months, or even years postoperatively with pain related to mechanical implant failure, often without additional signs of systemic infection. Findings: We present the case of a 59-year-old male who developed rapid disk degeneration and implant failure seven months following instrumented lumbar fusion surgery. The causal organism was found to be Micromonas micros, an anaerobic bacterium typically located in the oral cavity and associated with periodontal disease. The patient was found to have extensive oral caries, which were presumed to have occurred secondary to poor oral hygiene and his use of fentanyl lozenges for chronic back pain. The patient was treated with revision staged spinal surgery and long-term intravenous antibiotics. Conclusion/clinical relevance: This case highlights an unusual etiology of delayed postoperative spinal implant failure and provides evidence for periodontal disease as a source of hematogenous seeding in postoperative spinal infections. The orthopaedist should also be aware of the potential relationship between poor oral hygiene and the use of high sugar content fentanyl lozenges in treating chronic back pain in these patients.

The exploitation of forage fish species can modify the functioning of marine ecosystems potentially impacting the population status of predators. This may be the case for the western Mediterranean Sea, where a reduction in the biomass of two key pelagic forage fish (European anchovy Engraulis encrasicolus and European sardine Sardina pilchardus) could produce a change in the diet composition of their main predators, which would consume alternative preys or change the size of the prey consumed. Here, we aimed to investigate the potential effect of biomass reduction of sardine and anchovy in the western Mediterranean Sea on the trophic preferences of the little tunny (Euthynnus alletteratus), a medium-sized predator that present a high consumption of these forage fish. We compared its interannual trophic ecology by combining the analysis of stomach contents and stable isotopes. Specifically, we examined if the diet of little tunny changed in its main trophic habits (diet composition, prey size, and trophic niche) during a 6-year period. We found that small pelagic fish, especially clupeiformes, were the most important prey group for the little tunny during the study period. However, we found changes in the body size of anchovy and the relative importance of sardine in recent years, probably reflecting the reported reduction in the biomass and body size of these two forage fish in the study area. In addition to these changes, we found an increase in some demersal and benthopelagic species in the diet of little tunny, which could act as an alternative diet resource., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Study Design: This was a retrospective cohort study., Objective: The objective of this study was to analyze readmission rates among patients undergoing anterior cervical discectomy and fusion (ACDF), determine which factors were associated with higher readmission rates, and develop a scale for utilization during surgical planning., Summary of Background Data: ACDF is the most common surgical treatment for many cervical disk pathologies. With the Centers for Medicare and Medicaid Services selecting readmissions as a measure of health care quality, there has been an increased focus on reducing readmissions., Materials and Methods: There were 114,174 recorded ACDF surgeries in the derivation cohort, the State Inpatient Database (SID) of New York and California between 2006 and 2014. There were 115,829 ACDF surgeries recorded in the validation cohort, the SID from Florida and Washington over the same time period. After identification of risk factors using univariate and multivariate analysis of the derivation cohort, a predictive scale was generated and tested utilizing the validation cohort., Results: Overall, readmission rates within 30 days of discharge were 5.87% and 5.52% in the derivation and validation cohorts, respectively. On multivariate analysis of the derivation cohort, age older than 80 years [odds ratio (OR), 1.67] male sex (OR, 1.16), Medicaid insurance (OR, 1.90), Medicare insurance (OR, 1.64), revision ACDF (OR, 1.43), anemia (OR, 1.45), chronic lung disease (OR, 1.23), coagulopathy (OR, 1.42), congestive heart failure (OR, 1.31), diabetes (OR, 1.23), fluid and electrolyte disorder (OR, 1.56), liver disease (OR, 1.37), renal failure (OR, 1.59), and myelopathy (OR, 1.19) were found to be statistically significant predictors for readmission. These factors were incorporated into a numeric scale that, that when tested on the validation cohort, could explain 97.1% of the variability in readmission rate., Conclusions: Overall, 30-day readmission following ACDF surgery was 5%-6%. A novel risk scale based on factors associated with increased readmission rates may be helpful in identifying patients who require additional optimization to reduce perioperative morbidity., Level of Evidence: Level III-prognostic.

Since the discovery of phages in 1915, these viruses have been studied mostly in aerobic systems, or without considering the availability of oxygen as a variable that may affect the interaction between the virus and its host. However, with such great abundance of anaerobic environments on the planet, the effect that a lack of oxygen can have on the phage-bacteria relationship is an important consideration. There are few studies on obligate anaerobes that investigate the role of anoxia in causing infection. In the case of facultative anaerobes, it is a well-known fact that their shifting from an aerobic environment to an anaerobic one involves metabolic changes in the bacteria. As the phage infection process depends on the metabolic state of the host bacteria, these changes are also expected to affect the phage infection cycle. This review summarizes the available information on phages active on facultative and obligate anaerobes and discusses how anaerobiosis can be an important parameter in phage infection, especially among facultative anaerobes.

Case: We report the first documented case of chylous leak recognized intraoperatively during posterior spinal instrumentation and fusion for juvenile scoliosis in a female patient with a history of thoracotomy and decortication for an empyema., Conclusions: Thoracic duct injury can lead to severe morbidity and mortality because of chylothorax formation. Although chylous leaks are a well-documented complication of the anterior approach to spine surgery, leaks during the posterior approach are rarely reported. When these chylous leaks are recognized intraoperatively, the likelihood of serious complications may be minimized by drain placement before closure.

The number of studies of reproductive biology for Atlantic bluefin tuna carried out in the Gulf of Mexico is significantly lower than those undertaken in the Mediterranean Sea. Four spawning areas have been found for the eastern Atlantic bluefin tuna stock in the Mediterranean Sea, so it is not implausible that there is more than one spawning area in the Gulf of Mexico for the western Atlantic bluefin tuna stock. The individuals used in this study were caught as bycatch by the Mexican surface longline fleet between January and April 2015. A total of 63 individuals ranging between 192 and 293 cm L F (mean = 238 ± 22.52 cm) were measured. Gonads from 46 fish (31 females and 15 males) were collected for histological examination. All the individuals were classified as mature; 25 were reproductively active (in spawning capable and spawning stages). The histological analysis indicates spawning activity in Mexican waters (the southern Gulf of Mexico). Spawning occurred in March and April, when the sea surface temperature was 25.57 °C ± 0.69 in March and 27.03 °C ± 0.69 in April. Information on the location of the spawning areas is necessary for a correct management of species. The present study provides the first histological evidence of reproductive activity in Mexican waters, and indicates a wider spawning area, beyond just the northern zone, potentially encompassing the entire Gulf of Mexico., Competing Interests: The authors declare that they have no competing interests.

Most studies have excluded postoperative drain volumes in analyzing blood loss associated with scoliosis surgery. We sought to analyze patient and surgical factors that influenced postoperative drain outputs. A retrospective review was conducted on 50 consecutive patients who had undergone posterior spinal fusion with pedicle screw instrumentation and subfascial drain placement over a 6-year period at a single institution for adolescent idiopathic scoliosis. Postoperative drain volumes were correlated to patient factors, surgical variables, and change in postoperative hemoglobin values. The association between drain output volumes and the need for allogeneic blood transfusion was also analyzed using univariate and multivariate analysis. Total postoperative drain volume positively correlated with Cell Saver volume (r=0.28, P=0.049), units of packed red blood cells transfused intraoperatively (r=0.31, P=0.03), and a number of Ponte osteotomies (r=0.43, P=0.002). On the basis of multiple linear regression analysis, only the number of osteotomies performed was associated with increasing total drain volume (R=0.25, P=0.003). Total drain output did not correlate with postoperative change in hemoglobin (P=0.85), the need for postoperative blood transfusion (P=0.22), or the total volume of blood transfused perioperatively (P=0.06). Patients with large intraoperative blood loss or multiple osteotomies are more likely to have higher postoperative drain volumes. Drain volume alone, however, should not be used as a trigger for recommending a postoperative blood transfusion.

Low back pain is one of the most prevalent complaints of athletes at all levels of competition. The purpose of this literature review is to provide an overview of sport-specific injuries and treatment outcomes that can be used by healthcare providers to better recognize injury patterns and treatment options for different groups of athletes. To our knowledge, no prior comprehensive review of lumbar spine injuries in sports is currently available in the literature, and it is essential that healthcare providers understand the sport-specific injury patterns and treatment guidelines for athletes presenting with low back pain following an athletic injury. Injury mechanisms were found to vary significantly by sport, although some broad recommendations can be made with regards to optimal treatment for these injuries and return to play. Additionally, it was found that certain treatments were more beneficial and resulted in higher rates of return to play depending on the specific sport of the injured athlete. Healthcare providers need to be aware of the different injury patterns seen in specific sports in order to properly evaluate and treat these injuries. Furthermore, an individualized treatment plan needs to be selected in a sport-specific context in order to meet the needs of the athlete in the short and long term.

Objective: To determine the prevalence and variation of inferior vena cava filter (IVCF) use in the spine trauma population and evaluate patient and facility level factors associated with their use., Study Design: Retrospective cohort. Participants/Outcome Measures: Patients with spinal injuries were identified by ICD-9 codes from the National Trauma Data Bank (NTDB), the best validated national trauma database. Patients whose spine injuries were operatively treated and those who received IVCF were identified from procedure description fields. Additional information compiled included patient demographics, injury severity score (ISS), time until surgery, concomitant fractures, and facility level information. Multivariate logistic regression analyses were conducted to examine the relationship of associated factors for IVCF use., Results: Of the 120,920 patients identified with spinal injuries, 2.4% received prophylactic IVCF. Of the 13,273 patients with operatively treated spinal injuries, 8.2% received prophylactic IVCF. Of the 7,770 patients with spinal cord injury (SCI), 10.8% received prophylactic IVCF. The interquartile ranges of placement rates among centers demonstrated greater than 10 fold variation. Based on multivariate logistic regression, ISS score >12 demonstrated the strongest association with prophylactic IVCF (adjusted OR = 4.908). Concomitant pelvic and lower extremity fractures (adj OR 2.573 and 2.522) were also associated with their use., Conclusions: Currently the only data regarding existing IVCF use in the spine trauma population amounts to surveys. The present study provides the most detailed and objective information regarding their use in this setting. Even in the operatively treated and SCI subgroups, prophylactic filters were used in only a small percentage of cases but placement rates varied widely among centers. More severely injured patients (ISS >12) had highest odds of receiving prophylactic IVCF. Further study is needed to clarify their role in this vulnerable population.

Bacteriophages represent an alternative solution to control bacterial infections. When interacting, bacteria and phage can evolve, and this relationship is described as antagonistic coevolution, a pattern that does not fit all models. In this work, the model consisted of a microcosm of Salmonella enterica serovar Enteritidis and φ San23 phage. Samples were taken for 12 days every 48 h. Bacteria and phage samples were collected; and isolated bacteria from each time point were challenged against phages from previous, contemporary, and subsequent time points. The phage plaque tests, with the genomics analyses, showed a mutational asymmetry dynamic in favor of the bacteria instead of antagonistic coevolution. This is important for future phage-therapy applications, so we decided to explore the population dynamics of Salmonella under different conditions: pressure of one phage, a combination of phages, and phages plus an antibiotic. The data from cultures with single and multiple phages, and antibiotics, were used to create a mathematical model exploring population and resistance dynamics of Salmonella under these treatments, suggesting a nonlethal, growth-inhibiting antibiotic may decrease resistance to phage-therapy cocktails. These data provide a deep insight into bacterial dynamics under different conditions and serve as additional criteria to select phages and antibiotics for phage-therapy.

Crude oil contamination of soils and waters is a worldwide problem, which has been actively addressed in recent years. Sequencing genomes of microorganisms involved in the degradation of hydrocarbons have allowed the identification of several promoters, genes, and degradation pathways of these contaminants. This knowledge allows a better understanding of the functional dynamics of microbial degradation. Here, we report a first draft of the 44.2 Mbp genome assembly of an environmental strain of the fungus Scedosporium apiospermum. The assembly consisted of 178 high-quality DNA scaffolds with 1.93% of sequence repeats identified. A total of 11,195 protein-coding genes were predicted including a diverse group of gene families involved in hydrocarbon degradation pathways like dioxygenases and cytochrome P450. The metabolic pathways identified in the genome can potentially degrade hydrocarbons like chloroalkane/alkene, chorocyclohexane, and chlorobenzene, benzoate, aminobenzoate, fluorobenzoate, toluene, caprolactam, geraniol, naphthalene, styrene, atrazine, dioxin, xylene, ethylbenzene, and polycyclic aromatic hydrocarbons. The comparison analysis between this strain and the previous sequenced clinical strain showed important differences in terms of annotated genes involved in the hydrocarbon degradation process.

Study Design: Biomechanical study utilizing human cadaveric cervical spines., Objective: To quantitatively assess the effects on intervertebral motion of isolated unilateral cervical facet fracture, and after disruption of the intervertebral disc at the same level., Summary of Background Data: Clinical evidence has indirectly suggested that cervical facet fractures involving 40% of the height of the lateral mass can cause instability of the involved segment. No study to date has demonstrated the kinematic effects of such an injury in a cadaveric model of the cervical spine., Methods: Nine six-segment cervical spines were defrosted and fixated to a spine motion simulator capable to apply unconstrained bending moments in the three anatomical planes. The spines were subjected to a maximum torque of 2 N · m in flexion, extension, left and right lateral bending, and of 4 N · m in left and right axial rotation. Each spine was tested in the intact configuration (INTACT), and following two increasing degrees of injury at C4-C5: fracture of the facet (CF1), and CF1 with disruption of the intervertebral disc at the same level (CF2). Intervertebral kinematics was tracked via clusters of active markers fixated on each vertebra. Differences in kinematics between INTACT and the two injured configurations were assessed via one-way Analysis of Variance (P < 0.05)., Results: No significant differences were detected between INTACT and CF1 across all kinematic parameters (P > 0.05) at C4-C5. CF2, however, resulted in significant increase of flexion, left axial rotation, and left lateral bending with respect to INTACT (flexion at C4-C5: INTACT = 8.7° ± 3.5°; CF2 = 14.3 ± 5.7; P < 0.05)., Conclusion: Our findings suggest that superior articular facet fractures alone involving 40% of the lateral mass may not necessarily result in intervertebral instability under physiologic loading conditions. The addition of partial injury to the intervertebral disc, however, resulted in statistically significant increase in angular displacement., Level of Evidence: N /A.

Introduction: While preoperative urinary tract infection (UTI) has the potential to cause bacteremia and postsurgical acute prosthetic joint infections (APJIs), the influence of asymptomatic bacteriuria (AB) in these infections remains unclear. So the majority of guidelines not recommend the treatment of AB prior to the surgery. However, as patients with dementia usually cannot explain the symptoms of dysuria, the differential diagnosis between AB and UTI may be very difficult in this group of patients. The principal aim of the study was to compare the rate of positive urine culture at admission in patients with femoral neck fracture with and without dementia and secondarily try to assess the connection of positive urinoculture and postoperative acute gram-negative PJI., Methods: All patients with a femoral neck fracture underwent a urine culture on hospital admission and were prospectively recorded. Variables such as sex, age, institutionalization, dementia and other comorbidities, PJI rate, and in-hospital death were collected. The results of cultures were retrospectively revised. Patients who received postoperative antibiotics or had been diagnosed with UTI during hospital stay were excluded. Statistical comparisons between patients with and without dementia were performed using SPSS software version 17., Results: A total of 148 patients were included (52 with dementia). The rate of positive urine culture was 32% (n = 16) in patients with dementia and 11.5% in patients without dementia ( P = .003). Of these 16 patients with dementia and positive urine culture, 2 (12.5%) developed an acute gram-negative PJI, whereas there were no cases in the group without dementia ( P = .011)., Discussion: The only difference between UTI and AB is the expression of symptoms by the patient. However, as patients with dementia have difficulties to explain UTI symptoms, some UTI may be underdiagnosed., Conclusion: Patients with dementia have a statistically higher rate of presurgical positive urine culture compared with patients without dementia., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Between 2008 and 2011, the head of 150 Euthynnus alletteratus (Osteichthyes: Scombridae) caught inshore off the southeastern Iberian coast (western Mediterranean Sea) were examined for parasites. Two monogeneans, four didymozoid trematodes and four copepods were found. Parasite abundance showed a positive relationship with the annual sea surface temperature, except for Pseudocycnus appendiculatus, but negative with the sea depth (Capsala manteri, Neonematobothrium cf. kawakawa and Caligus bonito). Prevalences and mean abundances differed significantly among sampling areas, except for C. manteri, Oesophagocystis sp. 2 and Ceratocolax euthynni, and sampling years (Melanocystis cf. kawakawa, N.cf. kawakawa, P. appendiculatus and Unicolax collateralis). Results indicate that the parasite abundances of E. alletteratus in the western Mediterranean Sea depend mainly on regional environmental variables, which can show interannual variations. The presence of pelagic parasites, i.e. didymozoids and P. appendiculatus, could indicate that E. alletteratus migrates between inshore and offshore pelagic domains. The different parasite faunas reported in E. alletteratus populations from the western Atlantic Ocean and the Mediterranean Sea appear to point out the geographical host isolation. These results suggest that E. alletteratus inhabiting the western Mediterranean Sea performs inshore-offshore small-scale migrations, and not transoceanic migrations between the western Atlantic Ocean and Mediterranean Sea.

Background Context: Previous studies have found that insulin or insulin-like growth factor treatment can stimulate fracture healing in diabetic and normal animal models, and increase fusion rates in a rat spinal fusion model. Insulin-mimetic agents, such as zinc, have demonstrated antidiabetic effects in animal and human studies, and these agents that mimic the effects of insulin could produce the same beneficial effects on bone regeneration and spinal fusion., Purpose: The purpose of this study was to analyze the effects of locally applied zinc on spinal fusion in a rat model., Study Design/setting: Institutional Animal Care and Use Committee-approved animal study using Sprague-Dawley rats was used as the study design., Methods: Thirty Sprague-Dawley rats (450-500 g) underwent L4-L5 posterolateral lumbar fusion (PLF). After decortication and application of approximately 0.3 g of autograft per side, one of three pellets were added to each site: high-dose zinc calcium sulfate (ZnCaSO4), low-dose ZnCaSO4 (half of the high dose), or a control palmitic acid pellet (no Zn dose). Systemic blood glucose levels were measured 24 hours postoperatively. Rats were sacrificed after 8weeks and the PLFs analyzed qualitatively by manual palpation and radiograph review, and quantitatively by micro-computed tomography (CT) analysis of bone volume and trabecular thickness. Statistical analyses with p-values set at .05 were accomplished with analysis of variance, followed by posthoc tests for quantitative data, or Mann-Whitney rank tests for qualitative assessments., Results: Compared with controls, the low-dose zinc group demonstrated a significantly higher manual palpation grade (p=.011), radiographic score (p=.045), and bone formation on micro-CT (172.9 mm(3) vs. 126.7 mm(3) for controls) (p<.01). The high-dose zinc also demonstrated a significantly higher radiographic score (p=.017) and bone formation on micro-CT (172.7 mm(3) vs. 126.7 mm(3)) (p<.01) versus controls, and was trending toward higher manual palpation scores (p=.058)., Conclusions: This study demonstrates the potential benefit of a locally applied insulin-mimetic agent, such as zinc, in a rat lumbar fusion model. Previous studies have demonstrated the benefits of local insulin application in the same model, and it appears that zinc has similar effects., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Commentary on: Yagi M, Hosogane N, Watanabe K, Asazuma T, Matsumoto M, Keio Spine Research Group. The paravertebral muscle and psoas for the maintenance of global spinal alignment in patient with degenerative lumbar scoliosis. Spine J 2016:16:451-8 (in this issue)., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The head region of 72 bullet tuna Auxis rochei from the western Mediterranean Sea (south-east Spain and the Strait of Gibraltar) was examined for parasites. Seven metazoan species were found in the fish from south-east Spain: three monogeneans, two trematodes and two copepods, whereas only three species were isolated in the fish from the Strait of Gibraltar. A comparison of the levels of infection of the parasites according to fish size in south-east Spain showed that the prevalence of Didymozoon auxis and the mean abundance of Allopseudaxine macrova were higher in the larger hosts (range of fork length = 38-44 cm) than in the smaller ones (33-37 cm). A comparison of the parasite infections according to geographical region showed that the mean abundances of Nematobothriinae gen. sp. and Caligus bonito were higher in fish from south-east Spain than in those from the Strait of Gibraltar. A comparison of the parasite fauna of A. rochei from the Mediterranean Sea with the published data on Auxis spp. from the Atlantic, Indian and Pacific Oceans revealed the closest similarity between the Mediterranean A. rochei and the Atlantic A. thazard.

Pseudomonas aeruginosa is one of the Multi-Drug-Resistant organisms most frequently isolated worldwide and, because of a shortage of new antibiotics, bacteriophages are considered an alternative for its treatment. Previously, P. aeruginosa phages were isolated and best candidates were chosen based on their ability to form clear plaques and their host range. This work aimed to characterize one of those phages, ΦPan70, preliminarily identified as a good candidate for phage-therapy. We performed infection curves, biofilm removal assays, transmission-electron-microscopy, pulsed-field-gel-electrophoresis, and studied the in vivo ΦPan70 biological activity in the burned mouse model. ΦPan70 was classified as a member of the Myoviridae family and, in both planktonic cells and biofilms, was responsible for a significant reduction in the bacterial population. The burned mouse model showed an animal survival between 80% and 100%, significantly different from the control animals (0%). However, analysis of the ΦPan70 genome revealed that it was 64% identical to F10, a temperate P. aeruginosa phage. Gene annotation indicated ΦPan70 as a new, but possible temperate phage, therefore not ideal for phage-therapy. Based on this, we recommend genome sequence analysis as an early step to select candidate phages for potential application in phage-therapy, before entering into a more intensive characterization.

Background Context: Traumatic bilateral-atlantoaxial dislocations are rare injuries. Hangman fractures, conversely, represent 4% to 7% of all cervical fractures and frequently involve a combination C1-C2 fracture pattern. Presently, there is no report in the English literature of a traumatic C2-spondylolisthesis associated with a C1-C2 rotatory dislocation. This injury complex cannot be cataloged using current classification schemes and no established treatment recommendations exist., Purpose: To report a unique case of a Hangman fracture associated with bilateral C1-C2 rotatory-dislocation, which does not fit into existing classification systems, and discuss our treatment approach., Study Design: A clinical case report and review of the literature., Methods: Chart review and analysis of relevant literature. There were no study-specific conflicts of interest., Results: A 26-year-old man sustained a traumatic C2-spondylolisthesis along with C1-C2 rotatory subluxation in an automobile collision. The patient was originally placed in a halo crown and vest and then taken for an open reduction and stabilization through a posterior approach for persistent C1-C2 subluxation. The patient is currently 16 months postoperative and back to work as a plumber., Conclusions: The injury complex encountered cannot be described using the available classification systems. Our treatment included initial stabilization with halo placement, followed by a posterior C1, C2, and C3 segmental reduction and fixation resulting in radiographic fusion and a good clinical outcome., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Study Design: Retrospective uncontrolled case series., Objective: The purpose of this study was to determine the association, if any, between intraoperative blood loss and need for transfusion with the use of periapical (Ponte) osteotomies, as well as other patient and surgical variables among patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal instrumentation and fusion., Summary of Background Data: Blood loss during posterior spinal fusion for AIS can be substantial. Numerous techniques are used to minimize intraoperative blood loss and the need for allogeneic transfusion. However, it is unclear which patient and surgeon variables affect blood loss most significantly., Methods: A review was conducted on consecutive patients with AIS who had undergone posterior spinal fusion from July 1997 to February 2013 by a single primary surgeon at 1 institution. The relationship of estimated blood loss, normalized blood loss (normalized blood loss = estimated blood loss/number of levels fused/patient's weight in kilograms), autologous blood retrieved, and allogeneic transfusion received with various patient- and procedure-related variables were analyzed., Results: Estimated blood loss, normalized blood loss, and autologous blood retrieved were higher in patients who underwent periapical Ponte osteotomies (n = 38) (P < 0.0001, P < 0.001, P < 0.01, respectively). The mean major curve correction was 64% in patients without osteotomies, and 65% in patients with osteotomies (P = 0.81). All patients who underwent osteotomies (38/38) received allogeneic transfusion versus 26% (19/73) of those without osteotomies (P < 0.001). The likelihood of transfusion correlated with increasing number of osteotomies and a lower preoperative hemoglobin level (odds ratio, 3.34; P = 0.003; and odds ratio, 0.51; P = 0.02, respectively)., Conclusion: In patients with AIS undergoing posterior spinal fusion with instrumentation, performing periapical osteotomies increased all measures of intraoperative blood loss and need for transfusion without substantially improving major curve correction. As expected, a lower preoperative hemoglobin level was observed in patients who received a blood transfusion after posterior instrumentation and fusion., Level of Evidence: 4.

Bacterial infections are the second largest cause of mortality in shrimp hatcheries. Among them, bacteria from the genus Vibrio constitute a major threat. As the use of antibiotics may be ineffective and banned from the food sector, alternatives are required. Historically, phage therapy, which is the use of bacteriophages, is thought to be a promising option to fight against bacterial infections. However, as for antibiotics, resistance can be rapidly developed. Since the emergence of resistance is highly undesirable, a formal characterization of the dynamics of its acquisition is mandatory. Here, we explored the co-evolutionary dynamics of resistance between the bacteria Vibrio sp. CV1 and the phages V1G, V1P1, and V1P2. Single-phage treatments as well as a cocktail composed of the three phages were considered. We found that in the presence of a single phage, bacteria rapidly evolved resistance, and the phages decreased their infectivity, suggesting that monotherapy may be an inefficient treatment to fight against Vibrio infections in shrimp hatcheries. On the contrary, the use of a phage cocktail considerably delayed the evolution of resistance and sustained phage infectivity for periods in which shrimp larvae are most susceptible to bacterial infections, suggesting the simultaneous use of multiple phages as a serious strategy for the control of vibriosis. These findings are very promising in terms of their consequences to different industrial and medical scenarios where bacterial infections are present.

Our understanding of how biodiversity influences ecosystem functioning is entering a new stage of its development through the incorporation of information about the evolutionary relatedness of species. Bacteria are prime providers of essential ecosystem services, representing an excellent model system to perform biodiversity-ecosystem function research. By using bacteria isolated from petroleum-contaminated sites, we show that communities composed of poorly related species were more productive than those containing highly related species. The nature of the forces controlling this positive effect of phylogenetic diversity on community productivity depended on the number of species in culture. In communities of two species the positive effect of phylogenetic diversity on productivity was driven by changes in the selection effect. Communities of two distantly related species were dominated by the most productive species in monoculture, whereas communities of two closely related species were dominated by the less productive species in monoculture. In communities of four species the positive effect of phylogenetic diversity on productivity was driven by changes in the complementarity effect. In communities composed of four distantly related species the influence of positive interactions such as facilitation, cross-feeding, and niche partitioning seemed to outweigh the influence of negative interactions such as interference. As a consequence the proportion of species favored by the presence of other species increased as they became less related. Multiple facets of biodiversity may influence ecosystem functioning. Here, we present evidence of an interaction between phylogenetic and taxonomic diversity on community productivity, underlining the importance of considering multiple aspects of biodiversity when studying its impact on ecosystem functioning.

Despite their importance as ecosystem drivers, our understanding of the influence of bacterial diversity on ecosystem functioning is limited. After identifying twelve bacterial strains from two petroleum-contaminated sites, we experimentally explored the impact of biodiversity on total density by manipulating the number of strains in culture. Irrespective of the origin of the bacteria relative to the contaminant, biodiversity positively influenced total density. However, bacteria cultured in the crude oil of their origin (autochthonous) reached higher densities than bacteria from another origin (allochthonous) and the relationship between diversity and density was stronger for autochthonous bacteria. By measuring the relative contribution of each strain to total density we showed that the observed positive effect of increasing diversity on total density was mainly due to positive interactions among species and not the presence of a particular species. Our findings can be explained by the complex chemical composition of crude oil and the necessity of a diverse array of organisms with complementary enzymatic capacities to achieve its degradation. The long term exposure to a contaminant may have allowed different bacteria to become adapted to the use of different fractions of the crude, resulting in higher complementarity in resource use in autochthonous bacteria compared to allochthonous ones. Our results could help improve the success of bioaugmentation as a bioremediation technique by suggesting the use of a diversified set of autochthonous organisms.

Background Context: The rates of pseudoarthrosis after a single-level spinal fusion have been reported up to 35%, and the agents that increase the rate of fusion have an important role in decreasing pseudoarthrosis after spinal fusion. Previous studies have analyzed the effects of local insulin application to an autograft in a rat segmental defect model. Defects treated with a time-released insulin implant had significantly more new bone formation and greater quality of bone compared with controls based on histology and histomorphometry. A time-released insulin implant may have similar effects when applied in a lumbar spinal fusion model., Purpose: This study analyzes the effects of a local time-released insulin implant applied to the fusion bed in a rat posterolateral lumbar spinal fusion model. Our hypothesis was twofold: first, a time-released insulin implant applied to the autograft bed in a rat posterolateral lumbar fusion will increase the rate of successful fusion and second, will alter the local environment of the fusion site by increasing the levels of local growth factors., Study Design: Animal model (Institutional Animal Care and Use Committee approved) using 40 adult male Sprague-Dawley rats., Methods: Forty skeletally mature Sprague-Dawley rats weighing approximately 500 g each underwent posterolateral intertransverse lumbar fusions with iliac crest autograft from L4 to L5 using a Wiltse-type approach. After exposure of the transverse processes and high-speed burr decortication, a Linplant (Linshin Canada, Inc., ON, Canada) consisting of 95% microrecrystalized palmitic acid and 5% bovine insulin (experimental group) or a sham implant consisting of only palmitic acid (control group) was implanted on the fusion bed with iliac crest autograft. As per the manufacturer, the Linplant has a release rate of 2 U/day for a minimum of 40 days. The transverse processes and autograft beds of 10 animals from the experimental and 10 from the control group were harvested at Day 4 and analyzed for growth factors. The remaining 20 spines were harvested at 8 weeks and underwent a radiographic examination, manual palpation, and microcomputed tomographic (micro-CT) examination., Results: One of the 8-week control animals died on postoperative Day 1, likely due to anesthesia. In the groups sacrificed at Day 4, there was a significant increase in insulinlike growth factor-I (IGF-I) in the insulin treatment group compared with the controls (0.185 vs. 0.129; p=.001). No significant differences were demonstrated in the levels of transforming growth factor beta-1, platelet-derived growth factor-AB, and vascular endothelial growth factor between the groups (p=.461, .452, and .767 respectively). Based on the radiographs, 1 of 9 controls had a solid bilateral fusion mass, 2 of 9 had unilateral fusion mass, 3 of 9 had small fusion mass bilaterally, and 3 of 9 had graft resorption. The treatment group had solid bilateral fusion mass in 6 of 10 and unilateral fusion mass in 4 of 10, whereas a small bilateral fusion mass and graft resorption were not observed. The difference between the groups was significant (p=.0067). Based on manual palpation, only 1 of 9 controls was considered fused, 4 of 9 were partially fused, and 4 of 9 were not fused. In the treatment group, there were 6 of 10 fusions, 3 of 10 partial fusions, and 1 of 10 were not fused. The difference between the groups was significant (p=.0084). Based on the micro-CT, the mean bone volume of the control group was 126.7 mm(3) and 203.8 mm(3) in the insulin treatment group. The difference between the groups was significant (p=.0007)., Conclusions: This study demonstrates the potential role of a time-released insulin implant as a bone graft enhancer using a rat posterolateral intertransverse lumbar fusion model. The insulin-treatment group had significantly higher fusion rates based on the radiographs and manual palpation and had significantly higher levels of IGF-I and significantly more bone volume on micro-CT., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To assess whether systemic autoimmune diseases are a risk group for coeliac disease and if there is a systemic autoimmune diseases-associated enteropathy., Methods: 183 patients with systemic autoimmune diseases were included. Duodenal biopsy was carried out on patients with positive coeliac genetics (HLA-DQ2-DQ8) and/or serology and/or symptoms of the coeliac disease spectrum. When enteropathy was found, causes, including gluten sensitivity, were investigated and categorized according to a sequentially applied treatment. Results were analysed with Chi-square or Fisher exact tests., Results: The prevalence of coeliac disease with atrophy was 0.55% (1 of 183 patients). Thirty-eight of the 109 patients (34.8%) who underwent duodenal biopsy had lymphocytic enteropathy (8 infectious, 5 due to gluten sensitive enteropathy, 5 HLA-DQ2/DQ8 who did not accept gluten-free diet and 20 of unknown aetiology). Lymphocytic enteropathy was unrelated to disease activity or immunosuppressants. HLA-DQ2 was more frequent in connective tissue disease (41.5%) compared with systemic vasculitis and autoinflammatory diseases (17.9%) (p=0.02), whereas a lower percentage of lymphocytic enteropathy was observed in the former (20.2% vs. 41.6%). Lymphocytic enteropathy was clinically irrelevant in cases with no definite aetiology., Discussion: One third of systemic autoimmune diseases patients had enteropathy of uncertain clinical meaning in the majority of cases, which was rarely due to gluten sensitive enteropathy., (Copyright © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Cervical spondylotic myelopathy is a progressive disease and a common cause of acquired disability in the elderly. A variety of surgical interventions are available to halt or improve progression of the disease. Surgical options include anterior or posterior approaches with and without fusion. These include anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, cervical disc replacement, laminoplasty, laminectomy with and without fusion, and combined approaches. Recent investigation into the ideal approach has not found a clearly superior choice, but individual patient characteristics can guide treatment.

Ankylosing Spondylitis (AS) is a multifactorial and polygenic rheumatic condition without a well-understood pathophysiology (Braun and Sieper (2007)). It results in chronic pain, deformity, and fracture of the axial skeleton. AS alters the biomechanical properties of the spine through a chronic inflammatory process, yielding a brittle, minimally compliant spinal column. Consequently, this patient population is highly susceptible to unstable spine fractures and associated neurologic devastation even with minimal trauma. Delay in diagnosis is not uncommon, resulting in inappropriate immobilization and treatment. Clinicians must maintain a high index of suspicion for fracture when evaluating this group to avoid morbidity and mortality. Advanced imaging studies in the form of multidetector CT and/or MRI should be employed to confirm the diagnosis. Initial immobilization in the patient's preinjury alignment is mandatory to prevent iatrogenic neurologic injury. Both nonoperative and operative treatments can be employed depending on the patient's age, comorbidities, and fracture stability. Operative techniques must be individually tailored for this patient population. A multidisciplinary team approach is best with preoperative nutritional assessment and pulmonary evaluation.

As one of its primary physiological functions, sPLA(2)-IIA appears to act as an antibacterial agent. In particular, sPLA(2)-IIA shows high activity towards Gram-positive bacteria such as Staphylococcus aureus (S. aureus). This antibacterial activity results from the preference of the enzyme towards membranes enriched in anionic lipids, which is a common feature of bacterial membranes. An intriguing aspect observed in a variety of bacterial membranes is the presence of a broad but cooperative lipid chain melting event where the lipids in the membrane transition from a solid-ordered (so) into a liquid-disordered (ld) state close to physiological temperatures. It is known that the enzyme is sensitive to the level of lipid packing, which changes sharply between the so and the ld states. Therefore, it would be expected that the enzyme activity is regulated by the bacterial membrane thermotropic behavior. We determine by FTIR the thermotropic lipid chain melting behavior of S. aureus and find that the activity of sPLA(2)-IIA drops sharply in the so state. The activity of the enzyme is also evaluated in terms of its effects on cell viability, showing that cell survival increases when the bacterial membrane is in the so state during enzyme exposure. These results point to a mechanism by which bacteria can develop increased resistance towards antibacterial agents that act on the membrane through a cooperative increase in the order of the lipid chains. These results show that the physical behavior of the bacterial membrane can play an important role in regulating physiological function in an in vivo system.

Background Context: Injuries at the cervicothoracic junction are common in patients with ankylosing spondylitis. These injuries present challenges for both initial and follow-up imagings., Purpose: To describe a case of a patient with ankylosing spondylitis who was treated with laminectomy and a cervicothoracic orthosis for a spinal epidural hematoma after a nondisplaced fracture at the cervicothoracic junction and to discuss the merits of stand-up magnetic resonance imaging (MRI) for follow-up evaluation of this type of injury., Study Design/setting: Case report., Methods: Clinical data of a patient with ankylosing spondylitis who sustained a nondisplaced C7 fracture are presented, followed by a detailed review of the literature concerning imaging techniques available for the evaluation of cervical spine trauma in this patient population., Results: The patient was treated with emergent laminectomy and evacuation of the epidural hematoma, followed by definitive management in a cervicothoracic orthosis secondary to medical comorbidities. The patient was then successfully followed postoperatively with stand-up MRI because conventional imaging techniques could not adequately image the injury level in an upright position., Conclusions: Cervicothoracic injuries are common in patients with ankylosing spondylitis and may be difficult to follow with conventional imaging techniques. Stand-up MRI is a relatively new modality that may offer significant advantages over conventional imaging because of the ability to evaluate the cervicothoracic junction in a more functional position and the lack of a confining space such as that found in standard MRI units.

Study Design: Retrospective study of consecutive patients that were struck by motor vehicles and sustained spinal injuries over a 6-year period from 1997 to 2003., Objective: To determine spinal injury patterns and associated injuries in pedestrians struck by motor vehicles., Summary of Background Data: Motor vehicle accidents involving pedestrians are associated with high morbidity and mortality rates., Methods: All injured patients admitted to Level I Trauma and Regional Spinal Cord Injury Center were reviewed retrospectively to identify those who were struck by motor vehicles and sustained injury to the spinal column. Before 2001, clearance of the thoracolumbar (TL) spine was performed by plain radiographs. Beginning in 2001, such clearance was performed by helical truncal computed tomography of the chest/abdomen/pelvis (CT/CAP) that was performed to evaluate potential visceral injuries., Results: Of the 1672 patients who were struck by motor vehicles, 135 patients (8%) were found to have spinal injuries. Cervical injuries were found in 35%, thoracic in 19%, lumbar in 37%, and sacral injuries in 27%. Associated injuries were present in 99% of the patients. By relative risk analyses, there were no regional associations between injuries of the TL spine and injuries to the chest and abdomen. Patients frequently had combinations of injuries in distant locations, presumably from a "double-impact" injury mechanism. Before initiation of the CT/CAP protocol to clear the TL spine, 7% of patients had injuries initially missed by TL radiographs., Conclusions: Spinal injuries in pedestrians struck by motor vehicles are more evenly distributed throughout the spinal column and more often coexist with injuries to remote organs compared with car occupants and motorcyclists where regional tendencies and isolated spinal injuries are more frequent. A systematic approach to both diagnosis and treatment is, therefore, necessary. Helical truncal CT, performed to evaluate visceral injury, effectively screens for TL fractures.

Background/objective: Postprocedural infections are a significant cause of morbidity after spinal interventions., Methods: Literature review. An extensive literature review was conducted on postprocedural spinal infections. Relevant articles were reviewed in detail and additional case images were included., Results: Clinical findings, laboratory markers, and imaging modalities play important roles in the detection of postprocedural spinal infections. Treatment may range from biopsy and antibiotics to multiple operations with complex strategies for soft tissue management., Conclusions: Early detection and aggressive treatment are paramount in managing postprocedural spinal infections and limiting their long-term sequelae.

Methemoglobinemia, a condition associated with cyanosis and diminished pulse oximetry values, has been reported after use of local anesthetics to facilitate fiberoptic intubation. The majority of reports in the literature detail this development during diagnostic procedures such as endoscopy and bronchoscopy. A case of methemoglobinemia in a multiple-injury patient with an unstable compressive-flexion injury of the cervical spine undergoing fiberoptic intubation is presented. A literature review of this entity is also presented. The patient underwent fiberoptic intubation using topical pharyngeal anesthetics before planned cervical corpectomy, strut grafting and instrumentation. He became acutely cyanotic with abruptly diminished pulse oximetry readings. Subsequent blood gas analysis demonstrated methemoglobinemia. Intravenous methylene blue administration led to an uncomplicated resolution of the condition. Surgeons and anesthesiologists who manage such patients should be aware of methemoglobinemia, a rare but potentially fatal complication related to topical airway anesthetics.

Background: The optimal timing for surgical intervention after traumatic spinal injuries with spinal cord injury remains unclear., Design: Literature review., Findings: Multiple laboratory investigations (in animal models) and many clinical studies suggest better neurological outcomes with early surgical intervention. Conclusive evidence (well-designed randomized, controlled studies), however, is lacking, partly due to the logistics involved in executing such an investigation. Early surgery also appears to decrease the incidence of complications, reduces hospital stay, and helps reduce costs associated with acute management., Conclusion: Early surgical treatment is beneficial in terms of reducing complications, length of stay, and hospital costs. Further studies are needed to clearly demonstrate the impact of operative timing on neurological outcome.

Background: Magnetic resonance imaging has been shown to be of questionable accuracy in detecting recurrent meniscal tears after previous resection or repair., Purpose: To compare the accuracy of nonenhanced magnetic resonance imaging with that of intraarticular contrast-enhanced direct magnetic resonance arthrography and intravenous contrast-enhanced indirect magnetic resonance arthrography for detection of recurrent meniscal tears., Study Design: Prospective cohort study., Methods: Forty-one patients who had previous meniscal tears treated by resection or repair but who were experiencing recurrent knee symptoms were prospectively randomized into one of three groups: conventional magnetic resonance imaging, indirect arthrography, and direct arthrography. The interpretations of two musculoskeletal radiologists were compared with the findings of an arthroscopic procedure performed 2 to 14 weeks later., Results: Conventional imaging had a sensitivity of 57.9%, specificity of 80%, and overall accuracy of 62.5%. Intravenous contrast improved the sensitivity to 90.9%, specificity to 100%, and overall accuracy to 93.8%; intraarticular contrast had a sensitivity of 91.7%, specificity of 100%, and an overall accuracy of 92.9%., Conclusions: We demonstrated an increased accuracy of intravenous or intraarticular contrast-enhanced magnetic resonance arthrography in detecting recurrent meniscal tears. Both contrast routes demonstrated similar accuracy, a finding not previously reported.

Background: The halo skeletal device commonly is used both as primary treatment and as an adjunct to internal fixation in patients with cervical spinal injuries. For optimal outcome, the multidisciplinary team should have a basic understanding of the indications, design rationale, and complications associated with the halo skeletal fixator., Design: Literature review., Findings: The halo device provides the most rigid form of external cervical immobilization. Adherence to established application guidelines is critical to minimize morbidity. Safe zones for pin placement have been delineated. Protocols for management of pin-site infections have been established to appropriately manage these unfortunate complications., Conclusion: Although the halo is an effective form of cervical immobilization, complications with its use are encountered periodically. Familiarity with the design rationale, proper method of application, and potential complications can help to minimize the morbidity of this commonly used device.

Widespread use of adjusted low-dose warfarin has been limited by the inconvenience of outpatient laboratory monitoring and the perceived risk of bleeding complications. We sought to determine if the dose of warfarin could be lowered safely even further, eliminating the need for laboratory monitoring and lowering the complication rate. Two hundred forty-five Patients undergoing primary total joint arthroplasty (n = 245) were randomized prospectively to adjusted low-dose warfarin (international normalized ratio [INR], 1.4-1.8) or fixed minidose warfarin (2 mg daily, regardless of INR) before hospital discharge. Prophylaxis continued for 6 weeks, with twice-weekly laboratory monitoring. Patients were followed for bleeding, thromboembolic events, and minor reported complications of warfarin therapy. With the numbers available, the rates of thromboembolic and bleeding events were not significantly different using equivalence analysis. Of patients in the fixed group, 8% had INRs >3.1, necessitating a decrease in dosage to 1 mg. Although such a fixed-dose protocol may simplify outpatient prophylaxis, intermittent monitoring still would be required because a subset of patients achieve a moderate level of anticoagulation and would be at risk for bleeding complications.

Objectives: To determine which soft tissue structures are at risk and when joint violation can occur during small wire placement for hybrid external fixation of distal tibial fractures while adhering to published guidelines., Design: Cadaver anatomic experiment., Setting: University orthopaedic program. SUJBECTS: Five embalmed cadavers., Intervention: Placement of small wire transfixion pins in the distal tibia., Main Outcome Measurements: Dissection and measurements., Methods: Four orthopaedic surgeons were shown diagrams that have been widely accepted as allowing for placement of transfixion pins in the distal tibia through safe corridors. Each of the orthopaedic surgeons was then asked to place two transfixion pins into each of five cadaver legs in a position that would provide stable external fixation of the metaphysis to the diaphysis with a circular fixator (forty pins total) for a distal tibial fracture within five centimeters of the plafond. The specimens were dissected, and pins impaling neurovascular structures, tendons, or the ankle capsule were recorded. The superior capsular synovial reflections were measured from the anterior joint line and the tip of the medial malleolus. These measurements were also performed on arthrograms of two extremities before their dissection., Results: Fifty-five percent of the pins placed impaled at least one tendon that crosses the ankle joint. Neurovascular structures that were impaled included the saphenous vein (+/-10.5 percent) and the superficial peroneal nerve (+/-7.5 percent). One pin violated the superior capsular synovial reflection, which was an average of thirty-two millimeters (+/-1.58 millimeters) from the tip of the medial malleolus and twenty-one millimeters (+/-1.63 millimeters) from the anteromedial joint line., Conclusions: This study shows that tendons and neurovascular structures above the ankle are at risk during small transfixion pin placement, even when using safe corridors. Pins placed within two centimeters of the anterior joint line or three centimeters from the medial malleolus may be intracapsular.